What About the Fifth Child?

This blog from ACTION Director Hannah Bowen is the first in our World Immunization Week series on "Closing the Gap". Stay tuned for more posts from partners around the world! Follow us @ACTION_Tweets!

As a child, I learned pretty quickly that Bowen was a lucky last name to be born with. As I dutifully lined up in alphabetical order at school, I was always near the front – first to the playground for recess, first to the cafeteria for lunch. I never felt too much guilt about this luck; I knew everyone else would eventually have their turn.

But what if the end of the alphabet was never reached at all? What if the last few kids never had their turn, just because of the name they were born with?

It may sound ridiculous, but this is the current situation of global access to vaccines. Four out of five children in the world have access to basic life-saving vaccines. But as UNICEF Executive Director Tony Lake asks: “What about that fifth child? What about the 22 million newborn children around the world who are not so blessed? Who risk illness, uncertain futures, even death? Left behind because they live in remote, hard to reach, and underserved communities?”

The theme of this year’s World Immunization Week is “Closing the Gap”, and experts, advocates, health workers, donors, and communities are all discussing and (hopefully) taking action on what it will take to reach every last child with vaccines.

As a global health advocacy partnership that believes all people should have the chance to be healthy and live out their full potential, ACTION works to put community involvement and political accountability at the heart of efforts to close the immunization gap.

First, on accountability: if we are to close the gap, donors must deliver on the bold and ambitious pledges they made to Gavi, the Vaccines Alliance, a public-private partnership that supports poor countries to expand access to vaccines.

In Berlin in January, leaders pledged an ambitious $7.539 billion to Gavi’s work. Gavi estimates this funding will enable it to support the world’s poorest countries to vaccinate 300 million additional children from 2016-2020, preventing up to 6 million deaths.

Our new funding tracker clearly shows, however, that there is room for many countries to do more. Notably, Japan is slated to take over the G7 presidency, but was the only G7 country that did not chip in to fund Gavi for the next five years.

More work is also needed to turn pledges into real funding. Past ACTION funding trackers revealed strong follow-through by donor countries: in May 2014, 14 out of 17 major donors had delivered on their 2011-2015 commitments to Gavi. But there is no guarantee the new round of 2016-2020 pledges, from a wider variety of sources, will go as smoothly. Advocates must keep up the pressure on donors and ensure they fulfill their promises.

Then, when funding moves out the door, it must also be used for maximum impact – to reach that fifth child who has not yet been reached. To make sure that happens, Gavi must prioritize working with communities and involving civil society organizations.

ACTION recently collaborated on a report with Save the Childrenanalyzing how Gavi can help close the immunization gap and act effectively on its strategy, which emphasizes equity. Recommendations included prioritizing the hardest–to-reach children, investing in health systems, and playing a greater role in bringing down vaccine prices for governments beyond Gavi’s support. But the importance of community engagement cut across our analysis.

Since remote communities often have little access to information on vaccines, community service organizations (CSOs) create buy-in, ownership, and demand for immunization.

CSOs also help improve the planning, management, and performance of equitable health systems’ immunization programs. Since 2011, national CSO platforms have been established in at least 14 countries. In January, we sat down with Dr. D.S. Akram, member of the Gavi civil society steering committee and president of HELP – an NGO based in Pakistan that provides primary health care in hard-to-reach areas. Here’s what she said about the role of CSOs in supporting expanded immunizations:

“A strategic goal for Gavi was to increase demand and improve access to vaccination in inaccessible areas. Gavi has therefore supported the creation of a national CSO platform in Pakistan, and these same CSOs received funding to initiate projects in different parts. By meeting with elders, forming village committees, and suggesting solutions, we have also been helping to produce reports and case studies for Gavi that have been helpful to understand the situation on immunization in various regions…

With support from Gavi, CSOs are therefore making themselves increasingly visible in Pakistan -- the government has started recognizing and calling on CSOs more. For instance, the CSO platform in Pakistan is being consulted and included in budget and strategic planning for the health systems strengthening funding application being made by Pakistan this year. With the support of Gavi and with our increasing numbers, there is an opportunity for CSOs to help reach where the government has been unable to reach with vaccines. This can go a long way in creating sustainability by demand creation and motivation in these areas.”

This World Immunization Week, we’re motivated to keep pushing for accountability from donors and engagement from civil society to ensure all children have access to vaccines. Working together, we can close the gap so that every child, whatever her last name, wherever she is in the line at school, and wherever she was born in the world, has the same chance at a healthy start.